Electronic payment delivery service

ABSTRACT

Systems and methods for providing finance-related services such as electronic payment delivery are disclosed. In accordance with one embodiment, a payment system is configured to receive a payment message including a type of information, and to add an identification number to the message. The type of information is removed from the payment message, and the revised payment message is forwarded on to an entity responsible for payment. Particular embodiments in accordance with the present invention are suited for removing personal patient information from a HIPAA-compliant payment message, prior to forwarding the revised message over an electronic payment network.

CROSS-REFERENCE TO RELATED APPLICATION

The instant nonprovisional patent application claims priority from U.S.Provisional Patent Application No. 60/834,584, filed Jul. 31, 2006 andincorporated herein by reference in its entirety for all purposes.

BACKGROUND

Data communications networks are widespread in the United States. Manytypes of messages and transactions are sent through such networks,including electronic mail, news stories, and financial transactions.

Some data networks provide mechanisms for transmitting paymentinformation from a merchant to a financial institution and vice versa.These networks are sometimes referred to as payment processing networks.

Payment processing networks are generally highly reliable, secure, andfast. Point of sale (POS) terminals coupled to such payment processingnetworks are generally widely available at merchants and otherlocations.

While ubiquitous in mainstream commerce, payment processing networkshave so far not enjoyed widespread use in certain specialized fields,for example the healthcare industry. Specifically, it is estimated thatevery year there occur eight billion healthcare payment transactionsrepresenting roughly US $1.4 trillion.

FIG. 1 is a schematic diagram illustrating a simplified view ofconventional payment processing in the healthcare field. Specifically,FIG. 1 shows the conventional series of payment processing interactions100 occurring between a healthcare payer 101, healthcare provider 102,and a financial institution 104 of the healthcare provider. Examples ofhealthcare payers 100 include insurance companies. Examples ofhealthcare providers 102 include hospitals, doctor's offices, andpharmacies. Examples of financial institutions 104 include banks. Forpurposes of this patent application, the terms “payer” and “payor” areused interchangeably.

FIG. 1 shows the series of steps involved in conventional healthcarepayment processing. Once a patient has visited healthcare provider 102,in a first step 110 the provider submits, typically by form mailed topayer 101, a healthcare claim in compliance with §837 of the HealthInsurance Portability and Accountability Act (HIPAA). Enacted in 1996,HIPAA sets forth requirements addressing the security and privacy ofhealth data.

Payer 101 receives the healthcare claim, and reviews it for eligibilityto for payment under existing agreements with the patient and with thehealthcare provider. Based upon the results of this review, in step 112payer 101 returns to the healthcare provider 102 an Explanation ofBenefits (EOB), indicating the amount to be paid (if any) by payer 101for the medical services or products rendered to the patient by thehealthcare provider.

Payer 101 also provides payment to the healthcare provider based uponthe EOB. As shown in step 114, for approximately 75% of all claims,payment from the payer to the healthcare provider takes the form of apaper check. In step 116, this paper check must be forwarded on to thehealthcare provider's financial institution 104.

In a minority of cases, payment from payer 101 to healthcare provider102 may take the form of an Automated Clearing House (ACH) transfer 118of funds to financial institution 104 of the healthcare provider 102.Whether payment is provided to the healthcare provider by paper check orby ACH transfer, in step 120 the financial institution 104 must reportto healthcare provider 102, the status of the transactions through abank statement.

The conventional healthcare payment processing flow shown and describedin connection with FIG. 1 is characterized by a high intensity of manuallabor. Specifically, conducting financial transactions by paper check(the vast majority of the payment transactions) requires proper handlingand routing of paper checks at every stage of the process. Moreover, thehealthcare provider is required to manually reconcile the payment amountwith the data provided in the EOB and the original Healthcare Claimsubmitted under HIPAA. Such labor intensive activities drive up the costof the payment process and of the process for patients to inquire aboutthe status of their healthcare claims, and dispute those claims ifappropriate.

In addition, HIPAA mandated changes within the healthcare industry,including the adoption of standardized electronic data interchange (ED)message formats to exchange information, and the utilization ofelectronic forms of payment. Accordingly, banks, healthcare companies,and third party processing providers have an incentive to bring thehealthcare market the degrees of reliability, interoperability,security, and automation that exists in banking and the traditionalpayments arena.

Therefore, it would be desirable to provide a method and systemfacilitating the use of payment processing networks in the context ofthe healthcare industry.

SUMMARY

Embodiments in accordance with the present invention relate to systemsand methods for providing finance-related services such as electronicpayment delivery are disclosed. In accordance with one embodiment, apayment system is configured to receive a payment message including atype of information, and to add an identification number to the message.The type of information is removed from the payment message, and therevised payment message is forwarded on to an entity responsible forpayment. Particular embodiments in accordance with the present inventionare suited for removing personal patient information from aHIPAA-compliant payment message, prior to forwarding the revised messageover an electronic payment network.

Embodiments of the invention are directed to systems and methods forrouting funds, remittance data, and other financial information. Theinformation can be routed between parties, such as from institutionsoffering services such as bill payment or credit counseling to financialinstitutions performing services such as collection and paymentprocessing on behalf of billers. The information can be any appropriateinformation, such as transaction-based information or non-financialmanagement information. Data can flow between end users, such as from aconsumer to a biller, through the electronic payment delivery system,and can also pass through other entities such as a payment originatorand a biller financial institution. The payment service can providefunctionality such as payment, settlement, and financial reporting. Thedata can be transferred and stored in any appropriate format useful forfinancial institutions and the like. Particular embodiments inaccordance with the present invention are particularly suited for use inthe healthcare industry for processing payment requests in compliancewith §835 of HIPAA.

An embodiment of a system in accordance with the present inventioncomprises a host computer comprising a processor and a computer readablestorage medium. The computer readable storage medium has code storedthereon to direct the processor to receive a first payment message froma first entity, recognize a type of information in the first paymentmessage, and generate a revised payment message with an identifier, andwithout the type of information. Code stored on the computer readablestorage medium also directs the processor to forward the revised paymentmessage to a second entity to execute or facilitate the execution of apayment.

An embodiment of a method in accordance with the present invention forprocessing a healthcare payment, comprises, receiving from a healthcarepayer, a first electronic message instructing payment of a healthcareclaim. A type of information is recognized in the first electronicmessage. A revised payment message is generated with an identifier andwithout the type of information. The revised payment message isforwarded to a second entity to generate or facilitate execution of apayment.

An alternative embodiment of a method in accordance with the presentinvention, comprises, sending to a processor, a first electronic messageinstructing payment of a healthcare claim. A computational apparatus atthe processor recognizes in the first electronic message a type ofinformation, generates a revised payment message with an identifier andwithout the type of information, and then forwards the revised paymentmessage to a second entity to generate or facilitate execution of apayment. Notification of the payment is then received.

An alternative embodiment of a system in accordance with the presentinvention comprises, a processor configured to receive a firstelectronic message instructing payment of a healthcare claim; and acomputational apparatus at the processor. The computational apparatus isconfigured to recognize in the first electronic message a type ofinformation, and generate a revised payment message with an identifierand without the type of information. The computational apparatus isfurther configured to forward the revised payment message to a secondentity to generate or facilitate execution of a payment; and to receivenotification of the payment.

Other embodiments of the invention are directed to systems and methodsusing, accessing, and/or providing the above-described functionality andservices.

These and other embodiments of the invention are described in furtherdetail below.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 shows a simplified schematic view of a conventional process flowfor payment of healthcare claims.

FIG. 2 shows a simplified schematic view of interactions of anembodiment of a payment system in accordance with the teachings of thepresent invention.

FIG. 2A shows a simplified schematic view of interactions of analternative embodiment of a payment system in accordance with theteachings of the present invention.

FIG. 3 shows a simplified schematic view illustrating a process flow forpayment of healthcare claims utilizing the teachings of the presentinvention.

FIG. 4 shows a simplified block diagram of an embodiment of a paymentprocessing system in accordance with the teachings of the presentinvention.

FIG. 5 shows a simplified schematic view illustrating benefits accruingto various elements of the healthcare payment system illustrated in FIG.3.

FIG. 6 is a schematic illustration of a computer system for use inaccordance with embodiments of the present invention.

FIG. 6A is an illustration of basic subsystems the computer system ofFIG. 6.

DETAILED DESCRIPTION

Embodiments in accordance with the present invention relate to systemsand methods for providing finance-related services such as electronicpayment delivery are disclosed. In accordance with one embodiment, apayment system is configured to receive a first payment messageincluding a type of information, and to add an identifier such as anidentification number to form a revised payment message. The firstpayment message may or may not be the initial electronic message that issent in response to an interaction between a patient and a healthcareprovider, and may have been sent by a first entity such as a payer. Inembodiments of the invention, the type of information is removed fromthe first payment message, and the revised payment message is forwardedon to a second entity that is responsible for payment or that can helpfacilitate payment. Particular embodiments in accordance with thepresent invention are suited for removing personal patient informationfrom a §835 HIPAA-compliant payment message, prior to forwarding therevised message over an electronic payment network.

Embodiments of the invention are directed to systems and methods forrouting funds, remittance data, and other financial information. Theinformation can be routed between parties, such as from institutionsoffering services such as bill payment or credit counseling to financialinstitutions performing services such as collection and paymentprocessing on behalf of billers. The information can be any appropriateinformation, such as transaction-based information or non-financialmanagement information. Data can flow between end users, such as from aconsumer to a biller, through the electronic payment delivery system,and can also pass through other entities such as a payment originatorand a biller financial institution. The payment service can providefunctionality such as payment, settlement, and financial reporting. Thedata can be transferred and stored in any appropriate format useful forfinancial institutions and the like.

In accordance with one embodiment of the present invention, the paymentsystem may be used in conjunction with the confidential payment ofhealthcare claims in compliance with HIPAA. In certain such embodiments,an entity in the system is responsible for receiving from a payer apayment message in compliance with §835 of HIPAA, stripping certainpersonal information from the payment message, and inserting anidentification number into the message prior to forwarding the modifiedmessage onto an entity responsible for debiting funds from a financialinstitution of the payer, and crediting those funds to the financialinstitution of the healthcare provider. In accordance with certainembodiments, a third party healthcare processor may receive the messagefrom the payer and be responsible for stripping the personal informationand inserting the identification number. In accordance with otherembodiments, an administrator of the payment processing system itselfmay be receive an unaltered message directly from the payer, and beresponsible for the stripping and ID insertion functions.

The payment delivery service can be provided using any appropriatehardware, software, and network known or used in the art for suchpurposes. In one example, a central server or server cluster receives anelectronic message from a client computer over a network such as theInternet, processes information in the message, extracts any applicablerelated information from a central database, and sends a subsequentmessage or batch or messages to a computer or processor for a financialinstitution. Various computer and processing networks are known and usedin the art that can be similarly used for such purposes as known in theart.

In accordance with certain embodiments of the present invention,invention, a Universal Biller File (UBF) can be utilized to contain keypayment data for participating billers. This allows biller financialinstitutions to receive properly structured data, as well as the easygeneration of financial reports and exporting of financial data.

FIG. 2 shows a simplified schematic diagram showing interaction 200between an embodiment of an electronic payment system in accordance withthe present invention, and other entities. As shown in FIG. 2, in step201 consumer 202 interacts with payment originator 204, for example bymaking a purchase from a merchant. In step 206, the payment originator204 interacts with electronic payment system 208 in accordance with anembodiment of the present invention.

In step 208, electronic payment system 208 in turn forwards the paymentorder to the biller financial institution 212, which in step 214forwards the payment order to biller 216.

As shown in FIG. 2, electronic payment system 208 may perform a varietyof functions to expedite efficient handling of payment processingoperations. For example, as shown in step 250 the payments system 208may return rejected payment orders to the payment originator.

In addition, the electronic payment system 208 may serve as an effectiveintermediary between biller financial institution 212 and paymentoriginator 204. For example, as shown in step 252, the biller financialinstitution 212 may forward to payment originator 204 corrections andreturns via an administrative terminal controlled by the payment system208. Alternatively or in addition, as shown in step 254 the billerfinancial institution 212 may forward batch returns to the paymentoriginator 204 via payment system 208.

As shown in FIG. 2, payment system 208 may itself be responsible forgenerating particular information for forwarding to both the billerfinancial institution 212 and the payment originator 204. In particular,in step 256, the electronic payment system may create and distributereports of payment transactions to biller financial institution 212 andpayment originator 204.

In addition, as shown in step 258, the electronic payment system 208 maydistribute to payment originator 204 and biller financial institution212, updates to the Universal Biller File (UBF). In accordance withspecific embodiments, the electronic payment system may include a UBFwhich provides one or more of the following functionalities.

The UBF may function as a central database containing key payment datafor participating Billers. Examples of key biller data stored by the UBFmay include but are not limited to biller ID, name and address,financial institution ID and account number, and accounts receivableaccount structure, masks, and edit rules. Utilizing the UBF, billerfinancial institutions receive properly structured data after editingprocess. The UBF may also provide an online report viewer, and weeklydistribution of relevant information.

Embodiments in accordance with the present invention are not limited touse with a UBF. FIG. 2A shows a simplified view of an alternativeembodiment of a system according to the present invention, whichutilizes an electronic healthcare provider directory to facilitatepayments between payors and providers.

Specifically, in the system 260 of FIG. 2A, a payor 261 a-d may be inelectronic communication with gateway 262 of a healthcare paymentservice 263 either directly, or through an intermediary such as a payorsubsidiary 264, clearing house 265, or third party processor 266. As anexample, gateway 262 may be configured to receive information includingpayment/remittance of a healthcare claim according to the AmericanNational Standards Institute ANSI X12 standard for electronic datainterchange.

Information entering gateway 262 can be routed along different pathways.In one path 267, electronic remittance advice (ERA)/remittanceinformation flows from the healthcare payment service 263 out toproviders 268 a-d through an intermediary, for example a clearing house269, a bank 270, a healthcare service company 271, a payor/subsidiary272, or some other processor 273. Such ERA/remittance informationprovides details of the particular healthcare claim, for examplespecific procedures performed, drugs utilized, the identity of thepatient, and a breakdown of costs.

In a second path 274, payment and settlement information flows to apayment processing network 275 that is in electronic communication withfinancial institutions 276 and 277 affiliated with payors 261 andproviders 268, respectively. Such payment and settlement informationrelates to the total value of the healthcare claim that is to be paid,and can include information such as the account numbers of the accountfrom which the funds are to be transferred, and the destination accountfor the transferred funds. The payment and settlement information mayalso include a reassociation trace number and payor identificationinformation. The reassociation trace number allows for a uniqueidentification of claims and allows for the uniting of remittance claiminformation with payment claim information.

Financial institution 276 may be in communication with payors 261outside of the healthcare payment service regarding payment, settlement,and dispute support. Financial institution 277 may be in communicationwith providers 268 outside of the healthcare payment service regardingpayment and billing reconciliation information.

Healthcare payment service 263 may also include a provider directory278. Provider directory 278 may be in electronic communication with oneor both of the gateway 262 and the payment processing network 275.Provider directory 278 is an electronic database that would functionmuch like the UBF file of the Visa ePay system shown in FIG. 2.Specifically, the provider directory could be referenced to obtainvarious information relevant to specific providers, for example theproviders' bank account information, payment remittance instructions,the contact information at the provider, name and address information,and special instructions.

The information contained in the provider directory could be furnishedin advance and then stored on the system. For example, informationstored in the provider directory could be furnished by any partyauthenticated by the provider, including but not limited to the provideritself (such as hospital 268 a, Practice Group A 268 b, Practice Group B268 c, or Physician 268 d), a clearing house, a bank, a healthcareservice company, a subsidiary of the payor, or some other third partyprocessor.

During the process flow, all or only a subset of the information storedin the provider directory could then be referenced during the processflow. In the particular embodiment of FIG. 2A, one or more engines 291may be configured to reference the provider directory based uponrecognition of a flag or other specific content of the information (suchas provider identity) received at the gateway. In certain embodiments,information stored in the provider directory may not be accesseddirectly, but may be made available from the directory for reference.Because the information stored by the provider directory is maintainedinternal to the system, it need not be distributed to the payor orothers, and is thus not subject to interception and unauthorized use.

In accordance with embodiments of the present invention, the healthcarepayment service could also maintain a Healthcare Payor Directory 279.Healthcare Payor Directory 279 is in electronic communication with oneor both of the gateway and the payment processing network. HealthcarePayor Directory 279 could contain specific information relating to thepayor. Examples of information held by such a Payor directory 279 couldinclude the payor's bank account information, payment remittanceinstructions, contact information at the payor, name and addressinformation, and special instructions.

The information contained in the payor directory could be furnished inadvance and then stored on the system. For example, information storedin the payor directory could be furnished by any party authenticated bythe payor, including but not limited to the payor itself (such as one ofpayors 261 a-d), a payor subsidiary, a clearing house, or some otherthird party processor.

During the process flow, all or only a subset of the information storedin the payor directory could then be referenced during the process flow.In the particular embodiment of FIG. 2A, one or more engines 292 may beconfigured to reference the payor directory based upon recognition of aflag or other specific content of the information (such as payoridentity) received at the gateway. In certain embodiments, informationstored in the payor directory may not be accessed directly, but insteadmay be made available from the directory for reference. Because theinformation stored by the payor directory is maintained internal to thesystem, it need not be distributed to the provider or others, and isthus not subject to interception and unauthorized use.

As shown in FIG. 2A, information present in the directories 278 and 279could be referenced at various points during the transaction flows. Forexample, the directories could be referenced directly or indirectly toprovide information immediately after information enters the gateway.Alternatively, information in the directories could be referenced afterthe incoming information has left the gateway and been split up into therespective ERA/remittance and payment/settlement flows, respectively.Still further alternatively, information present in the directoriescould be referenced by the payment processing network.

Utilizing a system including an electronic provider directory and/orpayor directory according to certain embodiments, could offer certainadvantages. For example, the use of such directories would limit thedissemination of confidential information, such as bank accountinformation, contact information, or special instructions. This could beuseful both for reasons of financial security, as well as the privacyconcerns that are the subject of HIPAA.

While the healthcare payment service 263 is shown as a single entity inthe embodiment of FIG. 2A, this is not required by embodiments of thepresent invention. According to alternative embodiments, variousportions of the healthcare payment service 263 could be administered bydifferent entities.

For example, in one embodiments, the gateway 262 and flows 267 and 274could be administered by a first entity, for example one that isspecifically compliant with HIPAA requirements and qualified to maintainthe privacy of healthcare information. By contrast, one or more of thedirectories 278-279 and the payment processing network receiving thepayment and settlement flow could be administered by a second party thatis not HIPAA compliant, but which is qualified to maintain theconfidentiality of financial transactions.

In one example, an electronic payment service is provided in ahealthcare environment, allowing healthcare payers to direct payments tohealthcare providers using healthcare-compliant message formats whileremoving any personal healthcare information. Such a service can allowthe providers to avoid the expensive processing of personal checks,while allowing the payer to easily send an electronic payment. Theservice then can provide the provider with financial reporting regardingthe payments, and can handle the user's account information on behalf ofthe provider.

FIG. 3 provides a simplified schematic view of an example of a processand settlement flow 300 in accordance with an embodiment of the presentinvention. Specifically, FIG. 3 shows the interaction between healthcareprovider 302 and payer 304, as conducted through third party paymentprocessor 306, electronic payment network administrator 308 (e.g., anentity such as VISA®), a provider bank (or other financial institution)310 of healthcare provider 302, and a payer's bank (or other financialinstitution) 312 of payer 304. Each of the foregoing entities may havecomputational apparatus such as server and/or client computers, andthese computational apparatus may be operatively connected togetherthrough various communication media.

Prior to initiation of the process and settlement flow 300 shown in FIG.3, healthcare provider 302 delivers healthcare services and/or goods tothe patient. Healthcare provider 302 then forwards to payer 304, ahealthcare claim in compliance with §837 of HIPAA. The healthcareprovider 302 may forward the healthcare claim through any suitablemechanism including through the Internet or some other suitable computernetwork. The operation of such computer networks need not described indetail here as they are well known to those of ordinary skill in theart.

Payer 304 receives the healthcare claim, and reviews it for eligibilityfor payment under existing agreements with the patient (not shown) andwith the healthcare provider 302. Based upon the results of this review,a first entity such as the payer 304 submits a first payment message tothird party payment processor 306 in compliance with HIPAA §835 to payhealthcare provider 302 for services rendered.

In step 2 of FIG. 3, third party payment processor 306 receives thefirst payment message in compliance with §835 of HIPAA to pay thehealthcare provider 302, and then may perform a number of functions. Forexample, third party payment processor 306 can assign an ID number (orother identifier) to the §835 message. This ID number can be referencedfor designating particular information regarding the particular paymentmessage, and is useful in light of the next step, wherein third partypayment processor 306 strips or removes personal healthcare informationfrom the §835 first payment message, and then submits a batch ofpayments to the payment processing network administrator 308.

The stripping of personal healthcare information can occur in anysuitable manner. For example, in one embodiment, a revised messageincluding financial information, but not personal healthcare informationcan be created using the previously received first message. In anotherexample, personal healthcare information may be deleted from the firstmessage and thereby creating a revised message. In both cases, thestripping of personal information by the third party payment processor306 essentially renders anonymous the revised payment message that isultimately sent over the payment processing network. Third party paymentprocessor 306 may also return a notification message to the payer 304,acknowledging receipt of the HIPAA §835 message. This acknowledgmentmessage may include the assigned ID number associated with the revisedpayment message.

In preferred embodiments, revised payment messages may be aggregated andbatched before sending them to various financial institutions. Forexample, revised payment may be collected throughout the day and may beaggregated and sent in a batch to various financial institutions forprocessing a predetermined periodic intervals (e.g., once, twice orthree times per day).

In step 3 of FIG. 3, payment processing network administrator 308forwards payment instructions to provider's bank 310 with the ID number.In step 4 of FIG. 3, payment network administrator 308 sends anacknowledgement file to the third party payment processor 306.

In step 5 of FIG. 3, a second entity such as the payment networkadministrator 308 debits funds from the payer's bank account, creditsfunds to the provider's bank account, and makes available reportscorresponding to the ID number. In step 6 of FIG. 3, the payment networkadministrator 308 provides the third party payment processor 306 withreports at the end of the day. In step 7 of FIG. 3, the third partypayment processor 306 provides reporting and reconciliation services tothe provider 302 and the payer 304 with ID numbers.

Any of the reports that are described above may be output to anysuitable output device operatively coupled to a computational apparatus(as described above). Suitable output devices include displays,printers, etc. Such reports are useful as they inform various partiesincluding the payer, the provider, the payer's bank, the provider'sbank, and the patient with notification that healthcare services havebeen paid. The reports may include information such as identifiers,payer information, provider information, as well as payment information(e.g., the cost of the service performed as well as the amount paid bythe payer).

The embodiment of the electronic payment system illustrated in FIG. 3offers a number of features that assist in the efficient and accurateprocessing of healthcare claims. For example, the electronic paymentsystem allows healthcare providers to rapidly and efficiently receiveand process Payers' HIPAA §835-compliant payment messages, and createsreports to facilitate the healthcare provider's reconcilement of payerremittances.

The electronic payment system functions to maintain and protect Providerbank account information, handle payment reformatting and routine HIPAA§835 reporting for Provider and Payer reporting, provide Provider's Bankwith remittance information, settle with Payer and Provider, provideProvider and Payer with remittance and settlement reporting, andfacilitate back-office operations.

FIG. 4 shows a simplified block diagram of a system 400 for use inperforming payment processing in accordance with an embodiment of thepresent invention. System 400 comprises payment network administrator308 in electronic communication with third party processor 306, withfinancial institution 310 of a healthcare provider 302, and withfinancial institution 312 of a healthcare payer 304.

The network administered by administrator 308 may include dataprocessing subsystems, networks, and operations used to support anddeliver authorization services, exception file services, and clearingand settlement services. An exemplary payment processing network mayinclude VisaNet™. Payment processing networks such as VisaNet™ are ableto process credit card transactions, debit card transactions, and othertypes of commercial transactions. VisaNet™, in particular, includes aVIP system (Visa Integrated Payments system) which processesauthorization requests and a Base II system which performs clearing andsettlement services.

As shown in FIG. 4, the payment processing network administrator 308 mayinclude a server or host computer 402. A server computer is typically apowerful computer or cluster of computers. For example, the servercomputer can be a large mainframe, a minicomputer cluster, or a group ofservers functioning as a unit. In one example, the server computer maybe a database server coupled to a web server. The payment processingnetwork may use any suitable wired or wireless network, including theInternet.

As shown in FIG. 4, the host computer or server 402 of payment networkadministrator 308 may further include a computer readable storage medium404 and a processor 406. Server 402 is in electronic communication witha database 408 configured to store information pertaining to financialaccounts of payer 304 at financial institution 312 and of healthcareprovider 302 at financial institution 310.

An interchange software engine 410 is also shown as part of the paymentnetwork administrator 308 in the particular embodiment of FIG. 4.Interchange engine 410 may operate in conjunction with bank 412 of theadministrator 308 of the payment processing network, to arrange for thetransfer of funds from the financial institution of the payer to thefinancial institution of the healthcare provider. Interchange engine 410may also operate to calculate interchange fees and/or perform variousother interchange related functions.

Interchange engine 410 and any other software components or functionsdescribed in this application, may be implemented as software code to beexecuted by a processor using any suitable computer language such as,for example, Java, C++ or Perl using, for example, conventional orobject-oriented techniques. For example, any of the specific steps (orcombination of steps) shown in the Figures of an embodiment of thepresent application may be embodied as computer code on a computerreadable medium in any suitable combination. The software code may bestored as a series of instructions, or commands on a computer readablemedium, such as a random access memory (RAM), a read only memory (ROM),a magnetic medium such as a hard-drive or a floppy disk, or an opticalmedium such as a CD-ROM. Any such computer readable medium may reside onor within a single computational apparatus, and may be present on orwithin different computational apparatuses within a system or network.

In accordance with certain embodiments of the present invention, thecomputer-readable storage medium 404 of the host computer 402 may havecode stored thereon to direct the processor 406 to perform certaintasks. For example, code stored on the computer readable storage mediummay direct the processor to:

-   -   receive from a third party payment processor, a payment message        in compliance with HIPAA §835 having personal healthcare        information stripped therefrom and an ID number added;    -   forward to payer an acknowledgement of receipt of the payment        message, the acknowledgment optionally including the ID number;    -   perform an interchange function by debiting funds for the        healthcare payment from Payer's account at financial        institution, and credit funds for the healthcare payment to the        healthcare provider's account at financial institution;    -   provide reports to the third party payment processor identifying        payment transactions by ID number, for forwarding on to the        payer and healthcare provider for reconciliation purposes.

The particular embodiment of a payment system shown and described inFIG. 4 is provided for purposes of illustration only, and the presentinvention is not limited to this specific example. Thus, while FIG. 4shows the payment network administrator as being in electroniccommunication with a payer and healthcare provider indirectly through athird party processor, this is not required by the present invention.

In accordance with alternative embodiments of the present invention, thethird party processor is not present and at least the payer is in directelectronic communication with the administrator of the electronicpayment network. In such embodiments, a computer readable storage mediumof the administrator of the payment processing network may include codefor:

-   -   assigning an ID number to the message to allow its tracking in        the absence of the personal information stripped from the        message.    -   recognizing personal information present in a HIPAA compliant        §837 message;    -   removing that personal information from the message prior to        forwarding the revised message onto the financial institution of        the payer; and    -   forward to payer an acknowledgement of receipt of the payment        message, the acknowledgement optionally including the ID number;

Examples of personal information of a §835 HIPAA-compliant message whichmay be removed in accordance with embodiments of the present inventioninclude, but are not limited to the following fields from the NM1segment of a HIPAA 835 message: last name of patient (NM103), first nameof patient (NM104), middle name of patient (NM105), patient prefix(NM106), patient suffix (NM107), patient identifier (NM109), and alsothe procedure code and procedure line number information identifying themedical procedure.

Examples of types of information of a §835 HIPAA-compliant message whichmay be retained and forwarded in accordance with embodiments of thepresent invention include, but are not limited to fields from thefollowing HIPAA §835 segments: BPR (Financial Information); TRN (TraceInformation); Loop ID 1000A (Payer Information), including segments N1(Payer Name), N3 (Payer Address), N4 (Payer Geographic Location), REF(Payer Reference Identification), PER (Payer Contact Information), LoopID 1000B (Payee Information), including segments N1 (Payee Name), N3(Payee Address), N4 (Payee Geographic Location), REF (Payee ReferenceIdentification); TSA (Provider Summary Information); CLP (Claim LevelData); CAS (Claims Adjustment); and PLB (Provider Adjustment Data), andprovider identifier data, claim identifier data, and the procedure valuepaid.

As shown in FIG. 5, the embodiment of the electronic payment systemillustrated in FIG. 3 offers a number of possible advantages. Forhealthcare provider 302, the embodiment of the system offers substantialimprovement in back-office reconciliation, resulting in lower costs andincreased revenues. The system also offers the ability to closely tiepayments to healthcare claims remittances (§835s).

For payer 304, embodiments of the system offer lower payment costs,HIPAA compliance, and obviate the need to maintain Provider Registry.For third party processor 306, embodiments of systems in accordance withthe present invention offer increased processing revenue.

For administrator 308 of the payment processing network, the embodimentoffers an opportunity to increase transaction volume and hence revenue.The healthcare application also offers enhanced utilization of anexisting payment functionality (e.g., Visa® ePay). Embodiments of theinvention provide enhanced opportunities for members in healthcare

For the bank 412 of the payment processing network, embodiments inaccordance with the present invention offer paper checks replaced withelectronic payments, a higher revenue stream, enhanced informationbehind healthcare payments, and improved position competing for Payerand Provider account relationships.

It should be understood that the present invention as described abovecan be implemented in the form of control logic using computer softwarein a modular or integrated manner. Based on the disclosure and teachingsprovided herein, a person of ordinary skill in the art will know andappreciate other ways and/or methods to implement the present inventionusing hardware, software, and a combination of hardware and software

Any of the software components or functions described in thisapplication, may be implemented as software code to be executed by aprocessor using any suitable computer language such as, for example,Java, C++ or Perl using, for example, conventional or object-orientedtechniques. The software code may be stored as a series of instructions,or commands on a computer readable medium, such as a random accessmemory (RAM), a read only memory (ROM), a magnetic medium such as ahard-drive or a floppy disk, or an optical medium such as a CD-ROM. Anysuch computer readable medium may reside on or within a singlecomputational apparatus, and may be present on or within differentcomputational apparatuses within a system or network.

While the above embodiment has been described in connection with theePay electronic payment network administered by an entity such as Visa®,this example is provided for purpose of illustration only, and thepresent invention should not be limited to this particular electronicpayment network. Examples of alternative payment networks which may beutilized in accordance with embodiments of the present inventioninclude, but are not limited to, the Visa® Commerce system and VisaNet™.

Incorporated by reference herein for all purposes are the following U.S.Nonprovisional patent applications Ser. No. 10/418,989, filed Apr. 18,2003 and entitled “SYSTEM AND METHOD FOR PAYMENT OF MEDICAL CLAIMS”;Ser. No. 11/231,026, filed Sep. 20, 2005 and entitled “METHOD FORENCODING MESSAGES BETWEEN TWO DEVICES FOR TRANSMISSION OVER STANDARDONLINE PAYMENT NETWORKS”; Ser. No. 11/230,761, filed Sep. 20, 2005 andentitled “AUTO SUBSTANTIATION FOR OVER-THE-COUNTER TRANSACTIONS”; andSer. No. 11/230,743, filed Sep. 20, 2005 and entitled “METHOD AND SYSTEMFOR DETERMINING HEALTHCARE ELIGIBILITY”.

Other details of embodiments of the invention can be found in thefollowing U.S. patent applications, which are all herein incorporated byreference in their entirety for all purposes: 60/809,857, filed on May30, 2006; and 60/812,266, filed on Jun. 8, 2006.

A computer system configured to perform various functions of embodimentsof the present invention is represented generically in the drawing ofFIG. 6. Specifically, FIG. 6 shows computer system 610 including displaydevice 620, display screen 630, cabinet 640, keyboard 650, and mouse670.

Mouse 670 and keyboard 650 are representative “user input devices.”Mouse 670 includes buttons 680 for selection of buttons on a graphicaluser interface device. Other examples of user input devices are a touchscreen, light pen, track ball, data glove, microphone, and so forth.FIG. 6 is representative of but one type of system for embodying thepresent invention. It will be readily apparent to one of ordinary skillin the art that many system types and configurations are suitable foruse in conjunction with the present invention. In one embodiment,computer system 610 includes a Pentium class based computer, runningWindows NT operating system by Microsoft Corporation. However, theapparatus is easily adapted to other operating systems and architecturesby those of ordinary skill in the art without departing from the scopeof the present invention.

As noted, mouse 670 can have one or more buttons such as buttons 680.Cabinet 640 houses familiar computer components such as disk drives, aprocessor, storage device, etc. Storage devices include, but are notlimited to, disk drives, magnetic tape, solid state memory, bubblememory, etc. Cabinet 640 can include additional hardware such asinput/output (I/O) interface cards for connecting computer system 610 toexternal devices external storage, other computers or additionalperipherals, further described below.

FIG. 6A is an illustration of basic subsystems in computer system 610 ofFIG. 6. This diagram is merely an illustration and should not limit thescope of the claims herein. One of ordinary skill in the art willrecognize other variations, modifications, and alternatives. In certainembodiments, the subsystems are interconnected via a system bus 675.Additional subsystems such as a printer 674, keyboard 678, fixed disk679, monitor 676, which is coupled to display adapter 682, and othersare shown. Peripherals and input/output (I/O) devices, which couple toI/O controller 671, can be connected to the computer system by anynumber of means known in the art, such as serial port 677. For example,serial port 677 can be used to connect the computer system to a modem681, which in turn connects to a wide area network such as the Internet,a mouse input device, or a scanner. The interconnection via system busallows central processor 673 to communicate with each subsystem and tocontrol the execution of instructions from system memory 672 or thefixed disk 679, as well as the exchange of information betweensubsystems. Other arrangements of subsystems and interconnections arereadily achievable by those of ordinary skill in the art. System memory,and the fixed disk are examples of tangible media for storage ofcomputer programs, other types of tangible media include floppy disks,removable hard disks, optical storage media such as CD-ROMS and barcodes, and semiconductor memories such as flash memory,read-only-memories (ROM), and battery backed memory.

The above description is illustrative and is not restrictive. Manyvariations of the invention will become apparent to those skilled in theart upon review of the disclosure. The scope of the invention should,therefore, be determined not with reference to the above description,but instead should be determined with reference to the pending claimsalong with their full scope or equivalents.

One or more features from any embodiment may be combined with one ormore features of any other embodiment without departing from the scopeof the invention.

A recitation of “a”, “an” or “the” is intended to mean “one or more”unless specifically indicated to the contrary.

All patents, patent applications, publications, and descriptionsmentioned above are herein incorporated by reference in their entiretyfor all purposes. None is admitted to be prior art.

1. A system comprising: a processor; and a computer readable storagemedium, wherein the computer readable storage medium has code storedthereon to direct the processor to: receive a first electronic paymentmessage from a healthcare payor instructing a payment of a healthcareclaim on behalf of the healthcare payor to a healthcare provider,wherein the first electronic payment message is received over a networkbefore the payment is executed or facilitated on an electronic paymentprocessing network that processes credit and debit transactions;recognize a type of information in the first electronic payment message,wherein the type of information is associated with a patient; inresponse to receipt of the first electronic payment message, sendremittance information to the healthcare provider; in response toreceipt of the first electronic payment message, generate a revisedelectronic payment message with payment and settlement informationcomprising a reassociation trace number and payor identificationinformation, but without the type of information, wherein thereassociation trace number allows for the uniting of the remittanceinformation with payment claim information; and forward the revisedelectronic payment message to a payment network administrator to executeor facilitate the execution of the payment using the electronic paymentprocessing network, wherein the type of information is selected from: afirst, last, or middle name of the patient, including prefixes andsuffixes; a patient identifier; a procedure code; and a procedure linenumber.
 2. The system of claim 1 wherein the type of informationcomprises personal information of the patient.
 3. The system of claim 1wherein the first electronic payment message and the revised electronicpayment message comprise financial information of the healthcareprovider.
 4. The system of claim 1 wherein the revised electronicpayment message is in compliance with the Health Insurance Portabilityand Accountability Act (HIPAA).
 5. The system of claim 4 whereininformation that is in both the first and revised payment messagecomprises financial information, trace information, payor information,payee information, provider summary information, claim level data,claims adjustment information, or provider adjustment data.
 6. Thesystem of claim 4 wherein the system is controlled by a third partyhealthcare payment processor.
 7. The system of claim 4 wherein thesystem is controlled by a payment network administrator of theelectronic payment processing network.
 8. The system of claim 1 whereinthe code further comprises instructions to cause the system to forwardan acknowledgement of receipt of the payment message back to thehealthcare payor.
 9. The system of claim 1, wherein the code furthercomprises instructions to cause the system to generate a reportincluding the reassociation trace number and the healthcare payoridentification number associated with the revised payment message. 10.The system of claim 1, wherein the healthcare payor is compliant withHIPAA requirements and wherein the payment network administrator is notcompliant with HIPAA requirements.
 11. The system of claim 1, whereinthe code further comprises instructions to cause the system to batchmultiple revised electronic payment messages and periodically forwardthe batched revised electronic payment messages to the payment networkadministrator to execute or facilitate the execution of the paymentusing the electronic payment processing network.
 12. The system of claim1 wherein the code further comprises instructions to cause the system toprovide reconciliation services based on the reassociation trace numberand the healthcare payor identification number.
 13. The system of claim1 wherein the code that causes the processor to generate a revisedelectronic payment message further comprises code to reference ahealthcare payor directory to add healthcare payor information to therevised electronic payment message.
 14. The system of claim 1 whereinthe code further causes the processor to access a database to retrievehealthcare provider information, wherein the healthcare providerinformation comprises bank account information, a payment remittanceinstruction, contact information, and one or more special instructions.15. The system of claim 14, wherein the healthcare payor does not haveaccess to the healthcare provider.
 16. The system of claim 1, whereinthe code further causes the processor to aggregate and batch the revisedelectronic payment message and other revised electronic payment messagesbefore they are forwarded to the payment network administrator.
 17. Amethod of processing a healthcare payment, the method comprising:receiving from a healthcare payor, at a server computer, a firstelectronic message instructing payment of a healthcare claim on behalfof the healthcare payor to a healthcare provider, wherein the firstelectronic message is received before a payment is executed orfacilitated on an electronic payment processing network that processescredit and debit transactions; recognizing in the first electronicmessage a type of information at the server computer, wherein the typeof information is associated with a patient; sending remittanceinformation to the healthcare provider, in response to receipt of thefirst electronic payment message; generating, at the server computer, inresponse to receipt of the first electronic payment message, a revisedelectronic payment message with payment and settlement informationcomprising a reassociation trace number and a healthcare payoridentification number, but without the type of information; wherein thereassociation trace number allows for the uniting of the remittanceinformation with payment claim information; and forwarding the revisedelectronic payment message from the server computer to a payment networkadministrator to generate or facilitate execution of a payment using theelectronic payment processing network, wherein the type of informationcomprises: a first, last, or middle name of the patient, includingprefixes and suffixes; a patient identifier; an identity of a medicalprocedure performed; and a description of the medical procedureperformed.
 18. The method of claim 17 wherein the first electronicmessage is in compliance with the Health Insurance Portability andAccountability Act (HIPAA).
 19. The method of claim 18 whereininformation that is in both the first electronic message and the revisedelectronic payment message comprises financial information, traceinformation, payor information, payee information, provider summaryinformation, claim level data, claims adjustment information, orprovider adjustment data.
 20. The method of claim 17 wherein a thirdparty processor of healthcare claims generates the revised electronicpayment message.
 21. The method of claim 17 further comprisingforwarding an acknowledgement of receipt of the electronic paymentmessage back from the server computer to the healthcare payor.
 22. Acomputer readable medium comprising code for performing the method ofclaim
 17. 23. The method of claim 17 further comprising generating areport including the reassociation trace number and the healthcare payoridentification number associated with the revised payment message. 24.The method of claim 17, further comprising accessing a database andretrieving healthcare provider information, wherein the one or morehealthcare provider information comprises bank account information, apayment remittance instruction, contact information, and one or morespecial instructions.
 25. The method of claim 24, wherein the healthcarepayor does not have access to the one or more healthcare providerinformation.
 26. The method of claim 17, wherein the revised electronicpayment message and other revised electronic payment messages areaggregated and batched before forwarding to the payment networkadministrator.
 27. A method comprising sending to a processor, a firstelectronic message instructing a payment of a healthcare claim on behalfof a healthcare payor to a healthcare provider, wherein a computationalapparatus at the processor recognizes in the first electronic message atype of information, sends remittance information to the healthcareprovider, generates a revised electronic payment message with paymentand settlement information comprising a reassociation trace number and ahealthcare payor identification number and without the type ofinformation, and then forwards the revised electronic payment message toa payment network administrator to generate or facilitate execution of apayment, wherein the type of information is associated with a patient,and wherein first electronic message is sent to the processor before thepayment is executed or facilitated on an electronic payment processingnetwork that processes credit and debit transactions, and wherein thereassociation trace number allows for the uniting of the remittanceinformation with payment claim information, in response to receipt ofthe first electronic payment message, and wherein the type ofinformation comprises: a first, last, or middle name of the patient,including prefixes and suffixes; a patient identifier; an identity of amedical procedure performed; and a description of the medical procedureperformed; and receiving notification of the payment.
 28. A computerreadable medium comprising code, executable by a processor, forperforming the method of claim
 27. 29. A system comprising: a processorthat receives a first electronic message instructing payment of ahealthcare claim on behalf of a healthcare payor to a healthcareprovider before a payment is executed or facilitated on an electronicpayment processing network that processes credit and debit transactions;and a computational apparatus at the processor, the computationalapparatus recognizes in the first electronic message a type ofinformation, wherein the type of information patient, sends remittanceinformation to the healthcare provider, in response to receipt of thefirst electronic payment message, generates a revised payment messagewith payment and settlement information comprising a reassociation tracenumber and a healthcare payor identification number, and without thetype of information, in response to the receipt of the first electronicpayment message, wherein the reassociation trace number allows for theuniting of the remittance information with payment claim information,and then forwards the revised payment message to a payment networkadministrator to generate or facilitate execution of a payment using theelectronic payment processing network; and receives notification of thepayment wherein the type of information comprises: a first, last, ormiddle name of the patient, including prefixes and suffixes; a patientidentifier; an identity of a medical procedure performed; and adescription of the medical procedure performed.